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New roles for thalidomide

BMJ 1996; 313 doi: (Published 17 August 1996) Cite this as: BMJ 1996;313:377
  1. R J Powell, Consultant clinical immunologist
  1. Clinical Immunology Unit, Directorate of Medicine, University Hospital, Nottingham NG7 2UHs

    <it>A unique anti-inflammatory, but use it only when no alternatives exist</it>

    Thalidomide was synthesised in 1954 at Chemie Grunenthal, Germany. Four years later it was marketed as a sedative. It was considered a particularly safe drug, as even massive doses (up to 10 000 mg/kg) failed to kill laboratory rodents. Recognition in 1960 of its neuropathic potential, and in 1961 of its devastating teratogenic effects, led to the product licence being revoked in many countries, including Britain. However, use has continued in many countries around the world, and in Britain on the “named patient” basis. A clinical guideline for its safe use has been published.1

    No single mechanism has been identified which could account for all the clinical effects of thalidomide. It is an anti-inflammatory, immunomodulant drug, not an immunosuppressant. It acts on phagocytic cells and endothelial cells but has no direct effect on T lymphocytes. Specifically it modulates blood monocyte cytokine synthesis, particularly tumour …

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